Movement as Medicine: Can a Single Bout of Aerobic Exercise Elicit Exercise-induced Hypoalgesia in Youth With and Without Chronic Pain Syndromes?
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Boston Children's Hospital
- Enrollment
- 66
- Locations
- 1
- Primary Endpoint
- Pressure Pain Thresholds (PPT)
Study Overview
Brief Summary
Youth with chronic pain struggle to go to school, play sports, or spend time with friends and family due to pain. Medications are often ineffective, and aerobic exercise may improve both pain sensitivity and participation in valued life activities. This study will be the first to examine the impact of a single session of intense aerobic exercise on pain sensitivity measures in youth with and without chronic pain syndromes to help determine if aerobic exercise can improve pain and functioning.
Detailed Description
Pediatric chronic pain syndromes that occur in 11-38% of youth commonly impact participation in school, family, and recreational activities. Pediatric chronic pain and disability can persist into adulthood if left untreated. Central sensitization is an overarching mechanism of pediatric and adult chronic pain syndromes and is conceptualized as an imbalance in the facilitatory and inhibitory pathways that control pain signal traffic in the central nervous system. Aerobic exercise commonly recommended to improve pain and disability, but empirical evidence is lacking. Exercise-induced hypoalgesia (EIH) is a proposed mechanism by which aerobic exercise improves pain sensitivity and is characterized by improved pain sensitivity immediately following exercise. To date, EIH has not been studied in youth with chronic pain syndromes. Insights may reveal potential treatment targets and mechanisms by which aerobic exercise can improve pain and quality of life among youth suffering from chronic pain. This study aims to 1) evaluate and compare EIH responses in youth with and without chronic pain and 2) identify potential biopsychosocial contributors to EIH. The investigators hypothesize that EIH is robust in pain-free youth, and present but attenuated in youth with chronic pain (Aim 1) and that unhelpful beliefs about pain will attenuate the effects of exercise on pain sensitivity (Aim 2). Results from this study will provide highly relevant data to design a clinical trial studying the effects of chronic aerobic exercise on pain and disability in these youth. Identification of effective nonpharmacologic treatments for chronic pain, such as exercise, may also reduce dependence on prescription medications and improve child health.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Basic Science
- Masking
- None
Eligibility Criteria
- Ages
- 10 Years to 17 Years (Child)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Primary or secondary chronic pain syndrome
Exclusion Criteria
- •Allodynia (pain with light touch) at testing sites (non-dominant forearm)
- •Self-reported use of opioids in last week
- •Comorbid condition for which exercise is deemed unsafe by a physician or the (Physical Activity Readiness Questionnaire+) PARQ+
- •unable to safely ambulate on a treadmill
Arms & Interventions
Youth with Chronic Pain Syndromes
Youth with chronic pain will undergo quantitative sensory testing before and immediately after a single bout of intense aerobic exercise.
Intervention: Aerobic Exercise (Behavioral)
Youth without Chronic Pain Syndromes
Youth without chronic pain will undergo quantitative sensory testing before and immediately after a single bout of intense aerobic exercise. They will serve as a control group to determine if the intervention has different effects between groups.
Intervention: Aerobic Exercise (Behavioral)
Outcomes
Primary Outcomes
Pressure Pain Thresholds (PPT)
Time Frame: Before and after the intervention at baseline
A pressure algometer is applied 3 times to 2 sites: the dominant quadriceps and deltoid using the Force Ten FDX pressure gauge (Wagner Instruments, Greenwich, CT). The pressure at which the participant reports pain is recorded and averaged over the three trials. Higher PPTs represent less pain sensitivity.
Offset Analgesia Response
Time Frame: Before and after the intervention at baseline
Percent decrease in pain reported between T2 and T3 interval of the offset analgesia test. Higher values represent greater pain inhibition.
Temporal Summation of Heat Pain
Time Frame: Before and after the intervention at baseline
To evaluate constant noxious heat pain summation, a noxious heat stimulus (60/100 on a visual analogue scale) is held for 60 seconds. Temporal summation is defined by an exponential increase in pain at the test end relative to the start; greater values represent greater pain facilitation.
Secondary Outcomes
- Fitkids Treadmill Test(Single measurement at baseline)
- Functional Disability Inventory(Single measurement at baseline)
- Tampa Kinesiophobia Scale(Single measurement at baseline)
- Pain Catastrophizing Scale(Single assessment at baseline)
- Fear of Pain Questionnaire Child(Single assessment at baseline.)
- PROMIS Pediatric Pain Interference - Short Form 8a(Single assessment at baseline)
- Central Sensitization Inventory(Single assessment at baseline.)
- Numeric Pain Rating Scale(Baseline - before and after intervention)
- Highly Sensitive Child Scale(Single measurement at baseline)
Investigators
Julie Shulman
Physical Therapy Scientist
Boston Children's Hospital